UM Center for Contextual Psychology dedicated to World Domination through Peace, Love, and Understanding Values Work in ACT: Dignifying Treatment of Disordered Eating Emily K. Sandoz, M. S. & Kelly G. Wilson, Ph. D. Emily K. Sandoz, M. S. & Kelly G. Wilson, Ph. D.

Why I Care “Too much…”

Forms of Disordered Eating Varied topographies  AN, BN, BED Similar Patterning around food and body image  Rigid  Narrow  Insensitive Varied topographies  AN, BN, BED Similar Patterning around food and body image  Rigid  Narrow  Insensitive

Functions of Disordered Eating Similar Functions?  High levels aversive control Arousal Escape/avoidance  Low levels appetitive control Variability in orientation, etc. Positive reinforcement Similar Functions?  High levels aversive control Arousal Escape/avoidance  Low levels appetitive control Variability in orientation, etc. Positive reinforcement

ACT Model of Psychological Health

ACT for Disordered Eating Loosening aversive control  Present Moment, Acceptance, Defusion, Self Enhancing appetitive control  Present Moment, Values, Commitment, Self Loosening aversive control  Present Moment, Acceptance, Defusion, Self Enhancing appetitive control  Present Moment, Values, Commitment, Self

A Note on Values Identified as important in many traditions Recently emerging science of valuing Defined a number of different ways Some facilitate science Identified as important in many traditions Recently emerging science of valuing Defined a number of different ways Some facilitate science

Values In ACT, values are freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself.

Values In ACT, values are freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself.

Values are Behavior Not standards out in the world Not ideas or traits inside of us Things people do Not standards out in the world Not ideas or traits inside of us Things people do

Values In ACT, values are freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself.

Values are Freely Chosen Experienced as a free choice No “have-to” Determined by history Free from aversive control Experienced as a free choice No “have-to” Determined by history Free from aversive control

Values In ACT, values are freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself.

Values are Reinforcers Not objects Transition to a world that one would work for Not objects Transition to a world that one would work for

Values In ACT, values are freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself.

Values are Establishing Operations Another kind of transition A consequence already there becomes a reinforcer Another kind of transition A consequence already there becomes a reinforcer

Values In ACT, values are freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself.

Values are Intrinsic Independent of results or outcome Defined by relationship with the pattern Independent of results or outcome Defined by relationship with the pattern

Values In ACT, values are freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself.

Values take Different Forms Functionally defined  Forms change over time  Context-specific Functionally defined  Forms change over time  Context-specific

Values In ACT, values are freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself.

Values are Verbal Relational Frame Theory Transform functions or meaning of world without direct conditioning Relational Frame Theory Transform functions or meaning of world without direct conditioning

Values In ACT, values are freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself.

Deficits in Valued Living Repertoire dominated by behaviors that:  Lack freedom  Narrow, rigid, insensitive  Escape and/or avoidance  Reinforced by outcome Repertoire dominated by behaviors that:  Lack freedom  Narrow, rigid, insensitive  Escape and/or avoidance  Reinforced by outcome

Values & Medical Issues Values are not Goals  Medical stabilization often primary treatment goal Can do stabilization in a way that is valued or not  Chosen or not  For something or not Values are not Goals  Medical stabilization often primary treatment goal Can do stabilization in a way that is valued or not  Chosen or not  For something or not

Values & Medical Issues Medical risks ever present aversive  Introduce inflexibility in therapist  Can have those risks in a way that is valued or not Chosen or not For something or not Medical risks ever present aversive  Introduce inflexibility in therapist  Can have those risks in a way that is valued or not Chosen or not For something or not

Values Construction Shape valued living (successive approximations):  Assess valued living  Occasion experiential contact w/ values (valued living)  Establish as reinforcers for Tx & Bx change Shape valued living (successive approximations):  Assess valued living  Occasion experiential contact w/ values (valued living)  Establish as reinforcers for Tx & Bx change

Values Construction Shape valued living (successive approximations):  Determine where she is  Facilitate a step forward  Therapeutic contract around that  Repeat Shape valued living (successive approximations):  Determine where she is  Facilitate a step forward  Therapeutic contract around that  Repeat

Vulnerabilities & Permission Values & vulnerabilities intimate  Revealing how can be hurt Present own vulnerability first  Need the client to help Ask permission Values & vulnerabilities intimate  Revealing how can be hurt Present own vulnerability first  Need the client to help Ask permission

Values Work on a Continuum Continuum of valued living  Can be loosely described in stages  Vary in degree of intensity, brevity, location in time, explicitness of instruction, etc. Likelihood of defense Continuum of valued living  Can be loosely described in stages  Vary in degree of intensity, brevity, location in time, explicitness of instruction, etc. Likelihood of defense

Stage 1 Values Work Aiming for contact with any moment not dominated by aversive control Often found in moment just following relief Example: Free Breath Aiming for contact with any moment not dominated by aversive control Often found in moment just following relief Example: Free Breath

Stage 2 Values Work Aiming for moment dominated by appetitive control May or may not be linked to chosen values Example: Sweet spot Aiming for moment dominated by appetitive control May or may not be linked to chosen values Example: Sweet spot

Stage 3 Values Work Aiming for beginning of a pattern of choice Introducing world where choice would be possible Example: Magic Wand Aiming for beginning of a pattern of choice Introducing world where choice would be possible Example: Magic Wand

Stage 4 Values Work Aiming for increased patterning of valued living Introducing choice in this world, with its obstacles Example: A Free Choice Aiming for increased patterning of valued living Introducing choice in this world, with its obstacles Example: A Free Choice

A Word on Commitment Noticing when not engaged in valued living And turning back Seeing client where she is, and starting there Seeing self where you are, and starting there Noticing when not engaged in valued living And turning back Seeing client where she is, and starting there Seeing self where you are, and starting there

Thanks so much to Kelly Koerner, for inviting me. Thanks to the group for making me think all this through. Thanks to my mentor, Kelly Wilson, from whose words everything I say is wholly derivative. Thanks so much to Kelly Koerner, for inviting me. Thanks to the group for making me think all this through. Thanks to my mentor, Kelly Wilson, from whose words everything I say is wholly derivative.

For references, etc… Emily K. Sandoz Kelly G. Wilson For references, etc… Emily K. Sandoz Kelly G. Wilson